The Effect of Hukou Registration Policy on rural-to-urban Migrants’ Health Outcomes

The Effect of Hukou Registration Policy on rural-to-urban Migrants’ Health Outcomes

Presented by Marta BengoaCo-authored with Chris Rick

Colin Powell School. City University of New York School of Public Management at Syracuse University

@Bengoa_Marta

UNU-WIDER Conference on Migration and MobilityAccra, October 5-6 2017

Introduction and Motivation:

Hokou policy effect on rural-to-urban migrant’s health

Marta Bengoa 1/17Mobility and Migration Conference UNU-WIDER 2017

• China’s rapid development have spurred massive migration from rural areas tourban areas. That migration is mostly economically driven.

• Number of rural to urban migrants has increased dramatically. Between 1990 andthe end of 2015 the proportion of China's population living in urban areasjumped from 26% to 56%.

• Currently estimated there are more than 240 million rural migrants working inChina's biggest cities. That accounts for aprox. 30% of total rural labor force(China National Bureau of Statistics).

• As a consequence, we observe increasing income (wages) inequality between ruraland urban areas.

• The Hukou household registration system imposes restrictions and limits towhere to live –which is determined mainly by birth-. Hukou card is an internalpassport that sets access to education and health services. It started in 1956-58,relaxed during the 60s and enforced again since 1978.

Since China entered the WTO in 2002 the rapid industrial development to satisfy the global demand for exports increased the necessity for workers. We observe an exponential increase in urban population. Part of that increase in labor demand was fulfilled with migrants from rural areas

Source: Wing Chan 2008

Introduction and Motivation:

Hokou policy effect on rural-to-urban migrant’s health

Marta Bengoa 6/17Mobility and Migration Conference UNU-WIDER 2017

• As those migrants do NOT have an urban Hukou, they do not have access tohealth services unless totally private. Those private services are expensive andprevent most migrants to use it.

• The Hukou registration system is, de facto, a migration control system prompt tocreate inequality, social divergence and health outbreaks.

• Acquiring an urban-Hukou is highly difficult. It can be obtained only througheducation (university or graduate studies), by working for the Government or inhigh-ranked managerial position either for private company or for Stated-ownedfirms.

• Massive migration without access to health services –unless privately provided orvia informal networks- have the potential to create large negative externalities oncommunities, through decline in workers productivity and overall’s decline inpopulation health & wealth.

Objective:

Hokou policy effect on rural-to-urban migrant’s health

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• Our study focuses on the interconnection between internal migration fromrural to urban areas and health outcomes in China.

• We assess if there are observable differences in health outcomes migrantworkers an native-born urban residents.

• We use OLS regressions -in following research we will use a probit model-applied for two waves of data surveys (2008 and 2009) from IZA withindividual respondents to determine if restrictions on healthcare access arelinked to poorer health outcomes.

• We control for income, education, gender and other socio-economic variables.

Previous Literature:

Hokou policy effect on rural-to-urban migrant’s health

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• Studies have associated migration in developing economies with poor mental andphysical health (Li et al. 2006, Sun et al. 2008, Zhan et al. 2012). And evenengaging in more risky activities (links between HIV and migration in China,Hong (2006)

• There are not many studies that have addressed this link between healthoutcomes and Hukou system. The most recent is by Sun (2015), who uses self-reported outcomes (do I feel well or not, have I been sick?).

• Other studies suggest that migrants are reasonably healthy at the point ofmigration but more likely to experience adverse effects than non-migrants. Asthey get injured and can’t have access to health some return home while othersremain in urban areas. Therefore, increases risk of workplace accidents, othercontagious diseases (Chen, 2011; Lu and Quin, 2014; Wallace and Kulu, 2014).

Descriptive Statistics and Model:

Hokou policy effect on rural-to-urban migrant’s health

Marta Bengoa 9/17Mobility and Migration Conference UNU-WIDER 2017

• We use survey data reported in the Longitudinal Survey on Rural UrbanMigration in China from the Institute for the Study of Labor (IZA). The surveycollects data for 71,074 individuals (29,556 urban persons; 32,171 rural persons;and 9,347 migrants. Aprox 29% of rural persons) in two waves for the years 2008and 2009.

• The survey contains data on socioeconomic indicators, such as education,income, ethnicity, and hukou registration.

• IZA survey also includes data on many health indicators and outcomes. Theseinclude weight (kilograms), height (centimeters), dominant handedness, bloodpressure, and grip strength.

Descriptive Statistics and Model:

Hokou policy effect on rural-to-urban migrant’s health

Marta Bengoa 10/17Mobility and Migration Conference UNU-WIDER 2017

Descriptive Statistics and Model:

Hokou policy effect on rural-to-urban migrant’s health

Marta Bengoa 11/17Mobility and Migration Conference UNU-WIDER 2017

Descriptive Statistics and Model:

Hokou policy effect on rural-to-urban migrant’s health

Marta Bengoa 12/17Mobility and Migration Conference UNU-WIDER 2017

(1) Systolic Pressure =1age + 2insurancedummy + 3marrydummy +4smokerdummy +5 yearsofeducation+6 gender + 7 yrssincemigrating +ε

(2) DiastolicPressure = 1age + 2insurancedummy + 3marrydummy +4smokerdummy +5 yearsofeducation+6 gender + 7 yrssincemigrating +ε

(3) GripStrength = 1age + 2insurancedummy + 3marrydummy +4smokerdummy +5 yearsofeducation+6 gender + 7 yrssincemigrating +ε

(4) HealthRating = 1age + 2insurancedummy + 3marrydummy +4smokerdummy +5 yearsofeducation+6 gender + 7 yrssincemigrating +ε

• Grip strength, is good proxy of muscular strength, and a good indicator ofcurrent health, while blood pressure is reliable predictor for future cardiovasculardiseases and early mortality. Therefore, using grip strength as the dependentvariable will predict current health while using systolic or diastolic bloodpressure as the dependent variable will predict future health.

Descriptive Statistics and Model:

Hokou policy effect on rural-to-urban migrant’s health

Marta Bengoa 13/17Mobility and Migration Conference UNU-WIDER 2017

• We use Grip strength and blood pressure as proxies for health outcomes.Literature review, various research establishes these two measurements ascredible proxies for health (Sun et al., 2008; He et al., 2009; Schooling et al.,2011; Timpka et al., 2014; Diaz et al., 2014; and Mainous et al., 2016).

• We test if being a migrant with only rural Hukou in an urban area has anypredictive value for health outcomes, while controlling for age, education andother socio-economic variables.

Regression Results, R-squared is 0.69 and 0.75

systolicavg Coefficient Std. Error T-score

Married 0.27 0.03 4.51

Smoking habits -0.45 0.71 -1.82

Rural Hukou -0.53 0.69 2.07

Education 0.42 0.01 5.04

Gender (male) -0.70 0.00 -11.28

Age -0.35 0.00 -9.81

Years since immigration -0.04 0.05 -4.80

constant 1.03 0.06 2.26

Diastolic avg Coefficient Std. Error T-scoreMarried 0.19 0.03 2.35

Smoking habits -0.19 1.05 -0.65

Rural Hukou -0.48 0.04 2.74

Education 0.27 0.02 2.88

Gender (male) 0.37 0.00 8.02

Age -0.22 0.01 -7.59

Years since immigration -0.04 0.05 -2.19

Constant 1.88 0.00 3.19

Regression Results, R-squared is 0.73 and 0.74

Grip strenth Coefficient Std. Error T-score

Married 0.41 0.02 3.69Smoking habits -1.02 0.07 -2.45Rural Hukou -1.01 0.04 -2.85Education 0.31 0.10 2.09Gender (male) -1.27 0.00 -4.87Age -0.16 0.08 -2.58Years since immigration

-0.02 0.03 -3.78Constant 1.07 0.02 2.46

Health self-reported rating Coefficient Std. Error T-score

Married 0.16 0.01 3.18

Smoking habits -0.21 0.01 -5.56

Rural Hukou -0.35 0.01 -3.37

Education 0.22 0.00 3.28

Gender (male) -0.18 0.02 -2.93

Age -0.29 0.01 -3.34

Years since immigration -0.14 0.00 -3.61

Constant 1.46 0.00 5.32

Concluding Remarks:

• Results demonstrate that, migrant status is a significant predictor of healthoutcomes even after controlling for marriage, smoker status, age, and gender, therelationship holds to be able to predict health indicators.

• Migrants with urban Hukou insurance have a higher likelihood of presentingbetter health outcomes. Data from two survey waves in consecutive years confirmfor different individuals confirm that health outcomes of migrants with ruralHukou cards influence health outcomes negatively.

• Necessity to eliminate barriers to health access which are now linked togeography. China is as a trade-oriented economy that will still require migrationflows from rural areas to urban areas to fulfil production in manufacturing andservices (driven by domestic demand and trade). Migration will requireadjustments in health provisions to accommodate the changing spatialdemographics.

• Restricting migrants access to healthcare will clearly have an effect in the longrun, including on migrant’s health, productivity, and potential economic growth.

Hokou policy effect on rural-to-urban migrant’s health

The Effect of Hukou Registration Policy on rural-to-urban Migrants’ Health Outcomes

The Effect of Hukou Registration Policy on rural-to-urban Migrants’ Health Outcomes

Presented by Marta BengoaCo-authored with Chris Rick

Colin Powell School. City University of New York School of Public Management at Syracuse University

@Bengoa_Marta

UNU-WIDER Conference on Migration and MobilityAccra, October 5-6 2017